Healthcare Provider Details

I. General information

NPI: 1730398884
Provider Name (Legal Business Name): MR. CHADWICK JASON BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 OCILLA HWY BUILDING C
FITZGERALD GA
31750-3744
US

IV. Provider business mailing address

PO BOX 302
RHINE GA
31077-0302
US

V. Phone/Fax

Practice location:
  • Phone: 229-423-2039
  • Fax: 229-424-0339
Mailing address:
  • Phone: 229-385-1875
  • Fax: 229-424-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH018308
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: